Hastings Cent Rep. 2021 Mar;51(2):33-40. doi: 10.1002/hast.1243.
The practice around informed consent in clinical medicine is both inconsistent and inadequate. Indeed, in busy, contemporary health care settings, getting informed consent looks little like the formal process developed over the past sixty years and presented in medical textbooks, journal articles, and academic lectures. In this article, members of the Society of Teachers of Family Medicine (STFM) Collaborative on Ethics and Humanities review the conventional process of informed consent and its limitations, explore complementary and alternative approaches to doctor-patient interactions, and propose a new model of consent that integrates these approaches with each other and with clinical practice. The model assigns medical interventions to a consent continuum defined by the discrete categories of traditional informed consent, assent, and nondissent. Narrative descriptions and clinical exemplars are offered for each category. The authors invite colleagues from other disciplines and from the academic ethics community to provide feedback and commentary.
临床实践中的知情同意存在不一致和不充分的问题。事实上，在繁忙的现代医疗环境中，知情同意的过程看起来与过去六十年中在医学教科书、期刊文章和学术讲座中所呈现的正式流程大不相同。在本文中，家庭医学教师学会（STFM）伦理学和人文学科协作组的成员回顾了传统的知情同意过程及其局限性，探讨了医患互动的补充和替代方法，并提出了一种新的同意模式，将这些方法相互整合，并与临床实践相结合。该模型将医疗干预分配到一个由传统知情同意、同意和不同意这三个离散类别定义的同意连续体上。每个类别都提供了叙述性描述和临床范例。作者邀请来自其他学科和学术伦理界的同事提供反馈和评论。
